Hepatitis C Care

Diagnosis for Hepatitis C

Once you’ve been infected with hepatitis C, the virus stays in your body for life. Diagnosing an existing hepatitis C infection requires several blood tests.

Blood tests used in hepatitis C diagnosis:

1. Hepatitis C antibody test - A blood test that shows whether you've ever had hepatitis C. If this test comes back positive, your doctor will follow up with a viral load test.
2. Viral load test - A test that measures ribonucleic acid (RNA) in the blood. Viral RNA signals there is virus in your blood.
3. Genotype - If the viral load test is positive, you'll be given a blood test to determine which hepatitis strain (genotype) you have. There are currently six known genotypes. Knowing the genotype is essential as it determines which treatment you'll receive.

It’s important that you get tested for hepatitis C often if you’re at higher risk of contracting the disease. See if you should get tested and learn more about hepatitis C diagnosis.

Liver Damage

Once HCV infection is confirmed, the next step is determining the extent of damage. Non-invasive tests such as a CT scan, MRI or ultrasound can provide detailed images of the liver. A liver biopsy may be necessary to determine the degree of liver damage.

Phases of Hepatitis C

Acute Phase

The six month period of time after hepatitis C first enters your body is called the acute phase. Approximately 30 percent of people are able to clear the disease from their body naturally during this time.

During the acute phase, most people experience no symptoms at all, or they develop non-specific symptoms such as appetite loss or fatigue. Only about 20 percent of people who first get the virus develop jaundice.

Since symptoms are usually vague, most people do not know to seek medical help.

Reinfection

It’s important to note that if you are infected with hepatitis C and successfully clear the virus, you are not protected against reinfection.

Chronic Phase

The 70 percent of people whose bodies are unable to fight off the hepatitis C virus during the first six months of infection enter the chronic phase (long-term infection).

The chronic phase is diagnosed after the infection is identified on at least two different hepatitis C virus (HCV) RNA tests. The chance of your body naturally clearing the virus during the chronic phase is highly unlikely.

Nearly 25 to 30 percent of people who reach the chronic phase of hepatitis C will get cirrhosis.

Treatment for Hepatitis C

New treatments can clear hepatitis C at every stage. Of course, the disease causes damage over time, so it's best treat it as early as possible.

At UC San Diego Health, we treat hepatitis C with antiviral medications. The type of medications you receive is based on the strain (genotype) of hepatitis C you have. Treatment length depends on severity of condition and treatment response, and can range anywhere from 8 to 24 weeks.

Antiviral medications stop the enzymes produced by hepatitis C. This helps to:

• Prevent and slow the development of scarring in the liver.
• Reduce the chances of developing liver cancer and cirrhosis.
• Clear the virus from the bloodstream.

Antiviral Medications

In the past, the only treatment for hepatitis C was a combination of interferon alfa (self-injected) and ribavirin (pill). This regimen was often poorly tolerated and had suboptimal cure rates.

Depending on your genotype, new interferon-free treatments are available with cure rates over 90 percent.

Antiviral drugs used to treat hepatitis C:

• Ledipasvir – Sofosbuvir
• Daclatasvir – Sofosbuvir
• Elbasvir – Grazoprevir
• Sofosbuvir – Velpatasvir
• Glecaprevir – Pibrentasvir
• Sofosbuvir – Velpatasvir – Voxilaprevir
• Ribavirin

Factors That Affect Treatment

In addition to genotype, several factors impact the success of treatment and should be considered.

Treatment success is more likely if you:

• Are young
• Have a low amount of virus in your blood (known as hepatitis C viral load)
• Have moderate liver scarring
• Have a shorter length of time with infection (before fibrosis has occurred)

Lifestyle factors also play a role. Make sure to:

• Avoid alcohol
• Maintain a healthy weight
• Exercise regularly
• Eat healthfully

Monitoring Progress

Your level of hepatitis C virus will be periodically checked through the course of treatment. Expect to see your provider regularly for evaluation while on antiviral medications to monitor for side effects and response to treatment. 

Liver Transplant

Untreated hepatitis C can eventually develop into end-stage liver disease (decompensated cirrhosis), in which case liver transplantation is necessary.

Liver transplantation does not cure hepatitis C. If your infection is still present at the time of transplant, the new liver will become infected. However, treatment can be started after you recover from surgery.

More about our Liver Transplant Program